Hi215 Unit 5 Assignment 1

Medicare: Tends and Impact on Health Insurance 2 Medicare: Trends and Impact on Health Insurance Medicare is a national health insurance program that provides services for the elderly and other qualified individuals. Medicare is available for individuals who are 65 years or older, individuals who qualify for social security or railroad retirement and are disabled, government employees who have been disabled for more than 29 months, and insured workers and their spouses who have end stage renal disease, as well as children with end stage renal disease Casto 2013). Medicare is one of the largest health insurance programs in the world, accounting for 26% of healthcare expenditures, one-eight of the Federal Budget, and more than 3% of the nation’s Gross Domestic Product (GDP). Its impact upon health insurance, healthcare, the economy and American life in general has been massively significant (N.A. 2015). The Centers for Medicare and Medicaid Services (CMS) set the stage for trends and changes in how healthcare is delivered and reimbursed in this country. CMS covers 100 million people and their goal is to aim for better care at lower costs for overall improved health, not only of the elderly but of all Americans (N.A. 2015). The Social Security Act was amended in 1965 to create Medicare, and there have been many changes to the program over the years. There have been two major laws passed recently that have significantly impacted Medicare as a whole, the Affordable Care Act and the Healthcare and Education Reconciliation Act of 2010, together these laws are known as the Affordable Care Act (ACA) of 2012 (Casto 2013). The ACA contains provisions to improve quality of Medicare, establish new payment models, align Medicare payments with provider costs, and strengthen the integrity of Medicare as well as improve its financial footing. The Centers for Medicare and Medicaid Services (CMS) has developed the Medicare Advantage Value-Based Insurance Design Model. This will test the hypothesis that giving Medicare

HI215 Reimbursement MethodologiesUnit 4 Assignment Instructions and Worksheet(Use this document as a worksheet to complete this assignment)Objective: To evaluate the course outcome HI215-1:Examine the reimbursement processes of different health insurance plans. Point Value: 250 points. Assignment Activities include the following: 1. Review the Health Finance Case Study on “Primary Care Financial Management”(20 points) Questions: 1.What would you recommend that ABC Primary do to tighten up the financial of the practice? List at least three items along with your rational. 1)I would recommend that proper documentation for increases in salary.Rational: Proper documentation is necessary for payroll and without the proper paperwork; proof of what happened to the money is questionable. 2)I would also recommend proper documentation for bank statements and hire a professional accountant to keep the statements in order.Rational: In any business small or large, a legal accountant should be in place in order to follow up with audits and in order to again prove what happened to the money.3)I would also recommend the proper documentation for procurements and keep a record of anything that is bought or paid for. Rational: This only make sense when given a large amount of money, you would want to have the proper documentation to show the money is being used properly. 2. Review the provided OIG website link for any additional information and background. 2. Review the Health Finance Case Study on “Claims Management”. (10 points each/20 points)

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